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Hospitalisations at the end of life in four European countries : a population-based study via epidemiological surveillance networks

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Abstract
Background: There is a paucity of cross-national population-based research on hospitalisations of people at the end of life. We aimed to compare, in four European countries, the frequency, time, length of and factors associated with hospitalisations in the last 3 months of life. Methods: Population-based mortality follow-back study via Sentinel Networks of general practitioners (GPs) in Belgium, the Netherlands, Italy and Spain. Using a standardised form, GPs recorded the care in the last 3 months of life of every deceased practice patient (>= 18 years; 1 January 2009 to 31 December 2011). Sudden deaths were excluded. Results: We studied 4791 deaths that GPs described as non-sudden (66% of all registered deaths). Between 49% (the Netherlands) and 56% (Belgium) of patients were hospitalised at least once in the last 3 months of life. Readmissions were less frequent in the Netherlands (8%) than in the other countries (15-20%, p<0.001). Chances of being hospitalised increased over the last 10 days of life across countries but remained lowest in the Netherlands (Belgium: 21-37%, the Netherlands: 15-29%, Italy: 16-37%, Spain: 14-31%). Hospitalisations in the last week of life were more likely if patients resided at home rather than in a care home (ORs and 95% CIs Belgium: 1.94 (1.28 to 2.94); the Netherlands: 2.61 (1.10 to 6.18); Spain: 4.72 (1.64 to 13.57); non-significant in Italy) and less likely if the GP knew the patient's preferred place of death (ORs and 95% CIs Belgium: 0.52 (0.36 to 0.74); the Netherlands: 0.48 (0.25 to 0.91); Spain: 0.24 (0.13 to 0.44), non-significant in Italy). Conclusions: The use of hospitals at the end-of-life increased over the last weeks of life of patients in all countries studied, but remained lowest in the Netherlands, as did the rate of readmissions. This may be due to gatekeeping by GPs who are trained and supported in preventing hospital readmissions at the end of life.
Keywords
PALLIATIVE CARE, CANCER-PATIENTS, GENERAL-PRACTITIONERS, FAMILY PHYSICIANS, PREFERRED PLACE, ITALIAN SURVEY, DEATH, PREFERENCES, PROJECTIONS, ADMISSIONS

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Please use this url to cite or link to this publication:

Chicago
Pivodic, Lara, Koen Pardon, Guido Miccinesi, Tomas Vega Alonso, Sarah Moreels, Gé A Donker, Enrique Arrieta, Bregje D Onwuteaka-Philipsen, Luc Deliens, and Lieve Van den Block. 2016. “Hospitalisations at the End of Life in Four European Countries : a Population-based Study via Epidemiological Surveillance Networks.” Journal of Epidemiology and Community Health 70 (5): 430–436.
APA
Pivodic, L., Pardon, K., Miccinesi, G., Vega Alonso, T., Moreels, S., Donker, G. A., Arrieta, E., et al. (2016). Hospitalisations at the end of life in four European countries : a population-based study via epidemiological surveillance networks. JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 70(5), 430–436.
Vancouver
1.
Pivodic L, Pardon K, Miccinesi G, Vega Alonso T, Moreels S, Donker GA, et al. Hospitalisations at the end of life in four European countries : a population-based study via epidemiological surveillance networks. JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH. 2016;70(5):430–6.
MLA
Pivodic, Lara, Koen Pardon, Guido Miccinesi, et al. “Hospitalisations at the End of Life in Four European Countries : a Population-based Study via Epidemiological Surveillance Networks.” JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH 70.5 (2016): 430–436. Print.
@article{7105456,
  abstract     = {Background: There is a paucity of cross-national population-based research on hospitalisations of people at the end of life. We aimed to compare, in four European countries, the frequency, time, length of and factors associated with hospitalisations in the last 3 months of life. 
Methods: Population-based mortality follow-back study via Sentinel Networks of general practitioners (GPs) in Belgium, the Netherlands, Italy and Spain. Using a standardised form, GPs recorded the care in the last 3 months of life of every deceased practice patient ({\textrangle}= 18 years; 1 January 2009 to 31 December 2011). Sudden deaths were excluded. 
Results: We studied 4791 deaths that GPs described as non-sudden (66\% of all registered deaths). Between 49\% (the Netherlands) and 56\% (Belgium) of patients were hospitalised at least once in the last 3 months of life. Readmissions were less frequent in the Netherlands (8\%) than in the other countries (15-20\%, p{\textlangle}0.001). Chances of being hospitalised increased over the last 10 days of life across countries but remained lowest in the Netherlands (Belgium: 21-37\%, the Netherlands: 15-29\%, Italy: 16-37\%, Spain: 14-31\%). 
Hospitalisations in the last week of life were more likely if patients resided at home rather than in a care home (ORs and 95\% CIs Belgium: 1.94 (1.28 to 2.94); the Netherlands: 2.61 (1.10 to 6.18); Spain: 4.72 (1.64 to 13.57); non-significant in Italy) and less likely if the GP knew the patient's preferred place of death (ORs and 95\% CIs Belgium: 0.52 (0.36 to 0.74); the Netherlands: 0.48 (0.25 to 0.91); Spain: 0.24 (0.13 to 0.44), non-significant in Italy). 
Conclusions: The use of hospitals at the end-of-life increased over the last weeks of life of patients in all countries studied, but remained lowest in the Netherlands, as did the rate of readmissions. This may be due to gatekeeping by GPs who are trained and supported in preventing hospital readmissions at the end of life.},
  author       = {Pivodic, Lara and Pardon, Koen and Miccinesi, Guido and Vega Alonso, Tomas and Moreels, Sarah and Donker, G{\'e} A and Arrieta, Enrique and Onwuteaka-Philipsen, Bregje D and Deliens, Luc and Van den Block, Lieve},
  issn         = {0143-005X},
  journal      = {JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH},
  keyword      = {PALLIATIVE CARE,CANCER-PATIENTS,GENERAL-PRACTITIONERS,FAMILY PHYSICIANS,PREFERRED PLACE,ITALIAN SURVEY,DEATH,PREFERENCES,PROJECTIONS,ADMISSIONS},
  language     = {eng},
  number       = {5},
  pages        = {430--436},
  title        = {Hospitalisations at the end of life in four European countries : a population-based study via epidemiological surveillance networks},
  url          = {http://dx.doi.org/10.1136/jech-2015-206073},
  volume       = {70},
  year         = {2016},
}

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